Is Colossus Important in Understanding Injury Work?
Attorneys, doctors, and anyone else in the injury market itself is finding themselves running into Colossus. So first of all, let’s define what is meant when we say, “Colossus.”
Colossus is the blanket term for evaluation software that the insurance industry uses to determine benefits. It is also used to evaluate the severity, significance, and how benefits are determined for a patient.
So, Colossus is the software an insurance adjuster uses to determine benefits at the end of care. It can also be used in conjunction with other software to figure out what should be paid on injury claims.
Colossus can be really, really simple if you understand it. The injury market has done it’s best to make it far more complicated than it needs to be.
Colossus is very logical software
There are experts in the injury market who claim that you shouldn’t know anything about Colossus, that it’s all just a bunch of garbage.
On the other side, there are providers screaming, “Colossus is everything. It’s significant, so significant to anyone dealing with injured patients.”
So, who’s right?
Colossus is very logical software and here’s what we mean by that.
Let’s take an example using a doctor, since we’re all doctors here.
Imagine if the United States decided today that all doctors could no longer get business insurance for injuries. So, if a patient were to fall on your property, even right out in front of your office and right into some nice soft grass, if they injured themselves, you would be 100% responsible for those injuries.
So, lo and behold you glance outside, and a patient actually falls. You hustle outside, and it looks like they fell into that nice soft grass, so you think there’s no problem at all. After all, they got up like there was no problem.
Now, eight months later they come back to you and say, “Look doc, I need a check for $96,000.”
And you say, “For What?”
“Well, for the injuries I sustained on the day I fell on your lawn.”
Now you’re left speechless, and you’re thinking, “Let’s slow down, and go through this step by step.”
This is exactly how Colossus looks at the situation.
Your first question is going to be the same one Colossus asks.
The first question is simply, what was the injury?
This is the diagnosis. They are also known as ICD-9 or ICD-10 codes. You may see them referred to as injury codes. So, you use the diagnosis to code the injury.
Is the injury permanent?
That’s the second question that Colossus or you would need to determine. And, you would also want to know that if the injury was permanent, how was this determination made?
Today, we have things called permanent impairment, that’s the basis for permanent injury.
So, with $96,000 on the line, we need to explain it a little further.
With a permanent injury, you’d want to know, and Colossus wants to know, how are you going to substantiate this finding?
What made it permanent? What objective evidence do you have that an injury occurred in the first place?
Next, we would want to know if this permanent injury prevented the person from doing something they used to do in the future. That’s known as “loss of enjoyment of life.”
When a person can no longer do something as a result of an injury, it’s called loss of enjoyment of life or a disability.
Do not confuse this with a disability in the workplace. That is something else. Workplace disability speaks more to the inability due to injury of a person to earn a living.
We would also want to determine if there are things that the person does that now causes them pain as a result of the injury they sustained. Is the person chronically in pain as a result of having to perform these activities. Those are known as duties under duress factors. So, we would want to know that.
Now, if we have an injured person, who has some sort of duties under duress for loss of enjoyment of life, they may also require ongoing care. That care is labeled as future medical expenses.
Let’s break it down into logical steps:
- We need to know what doctor the injured person saw. What they decided the diagnosis was and where the injuries were on the person.
- We would need to know if the injuries were permanent, and how this was established.
- We also need to know how this was substantiated and documented.
That’s how Colossus works.
As doctors, we need to go through the same logical process as Colossus. Now, there are other things but simply put this is the essence of the software and the process you need to be following.
There’re five major things that all injury claims require:
- Diagnosis of the injury.
- Establishment of permanency.
- How does this injury interfere with their daily lives?
- How does this injury alter their future plans?
- Determination of the need for ongoing care.
Now, in practice it’s a little more complicated than what I just explained, but if the doctors in the spinal injury market would just nail down those five things, it would be a whole lot easier. It would be easier on everyone involved in a claim, from the patients, to the attorneys, and to the insurers. If we handle this and document it properly, we cut down massively on the hassles involved with injury claims.
Everyone in the injury market should understand how claims and injuries are assessed.
We do have some common misunderstanding in the injury market. Let me give you an example.
One of the biggest things attorneys misunderstand is that there are guidelines for worker’s comp in their state and then there are separate guidelines for everything else. The worker’s comp guideline may state that you use the third edition of the impairment guides, that does not mean that, that’s what’s used with auto accident injuries.
The more standardized we can make the process, the more misunderstandings we can eliminate from the injury market.
We are starting to see this routinely happening in the U.S. by what we call the SmartInjuryDoctor®. These doctors train to serve the spinal injury market effectively. They are not trained to increase or inflate benefit claims. They’re actually trained to serve the market efficiently and reduce a patient’s need for future benefits by getting extremely good results.
Colossus is a logical process. Injury workups can be a logical process. When you understand both, it’s amazingly easy to provide what everyone associated with the injury market needs.
Patients need an accurate diagnosis and great treatment results, attorneys need incredible and simple to understand documentation, and insurance companies need the same thing too.
When an injury doctor provides this, everyone in the market wins. The adversarial environment reduces itself and that’s what the SmartInjuryDoctor® produces daily.
No doctor in the injury market needs to know everything about Colossus, but a basic understanding can improve your documentation. This shouldn’t be hard if you follow a logical process using common sense to know what the software is really needing to process a claim.